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NOTE: We never sell, transfer or in anyway give out and/or divulge our clients', or perspective clients', information.

Your Company Name    
Your Name    
Your Title  
(owner, CEO, President, Etc.)
Your Email Address: 

Phone:  Fax:   

Comments/Questions:
  

Your Domain Name
" "

I currently do not have a Domain Name Registered and I want to take advantage of your 'No Additional Charge' service to register a Domain Name.

My first choice is
Second choice is
Third choice is    

I select the following Hosting Plan :

Economy  (X) ( ) $227.40 per year.

Basic        (X) ( ) $299.40 per year.

Expanded (X) ( ) $419.40 per year.

Maximum (X) ( ) $539.40 per year.

There is a 20% setup fee for each of these Hosting plans.

There are no Additional Hosting or Registration, fees for any of the above standard plans.

Please list any special offer or discount that you qualify to receive:

Your Satisfaction Guaranteed
If within the first 30 days you are not completely
satisfied with our service you will get
a 100% refund (less the setup fee)...
No Questions Asked.

PAYMENT

Check            (X) ( )
Money Order (X) ( )

Make Checks and Money Orders payable to WHITED SERVICES
and Mail To: 112 Mol Senia Lane - Round O, SC 29474

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